Glomerular Collapse Associated With Subtotal Renal Infarction in Kidney Transplant Recipients With Multiple Renal Arteries

被引:18
作者
Canaud, Guillaume [2 ]
Bruneval, Patrick [2 ]
Noel, Laure-Helene [3 ]
Correas, Jean-Michel [2 ,4 ]
Audard, Vincent [5 ]
Zafrani, Lara
Rabant, Marion [2 ]
Timsit, Marc-Olivier [1 ]
Martinez, Frank
Anglicheau, Dany [2 ]
Thervet, Eric [2 ]
Patey, Natacha [3 ]
Legendre, Christophe [2 ]
Zuber, Julien [2 ]
机构
[1] Hop Necker Enfants Malad, Serv Urol, F-75015 Paris, France
[2] Univ Paris 05, Paris, France
[3] Hop Necker Enfants Malad, Lab Anatomopathol, F-75015 Paris, France
[4] Hop Necker Enfants Malad, Serv Radiol, F-75015 Paris, France
[5] Hop Henri Mondor, Serv Nephrol & Transplantat, F-94010 Creteil, France
关键词
Collapsing glomerulopathy; renal transplant; renal infarction; FOCAL SEGMENTAL GLOMERULOSCLEROSIS; VASCULAR-PERMEABILITY FACTOR; PARIETAL EPITHELIAL-CELLS; PODOCYTES; TRANSDIFFERENTIATION; GLOMERULONEPHRITIS; NEPHROPATHY; VEGF; HIV;
D O I
10.1053/j.ajkd.2009.07.014
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Collapsing glomerulopathy is an aggressive kidney disease with rapid progression toward end-stage renal disease. Rare cases of de novo collapsing glomerulopathy have been reported during the post-transplant course and, in some instances, have been associated with renal graft vascular lesions. This finding raises the important question of whether ischemia could induce podocyte transdifferentiation, a hypothesis supported by evidence of hypoxia-inducible factor-dependent podocyte proliferation in HIV-associated nephropathy. We describe here 3 HIV-negative kidney transplant recipients in whom early graft biopsy performed in the vicinity of segmental graft infarction disclosed the typical features of glomerular collapse. Podocyte transdifferentiation was characterized by hallmark lesions, such as loss of mature podocyte phenotype, podocyte proliferation, and acquisition of a macrophage-like phenotype. Together, these data suggest that acute glomerular ischemia may lead to glomerular collapse in kidney transplants. Am J Kidney Dis 55: 558-565. (C) 2010 by the National Kidney Foundation, Inc.
引用
收藏
页码:558 / 565
页数:8
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